Liver transplant is treatment of choice if stable Liver Cancer Hepatocellular

Liver transplant is treatment of choice if stable

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Liver transplant is treatment of choice if stable Liver Cancer Hepatocellular Carcinoma (HCC), malignant hepatoma, cholangioma, & cholangiocarcinoma o Metastatic tumor more likely than a primary tumor Increased incidence due to chronic hepatitis C Causes & risk factors: o Chronic hepatitis B & C virus o Alcoholic cirrhosis o Obesity & diabetes o Hemochromatosis – too much iron toxic to the liver o NASH – fatty liver Cancer of the liver is more common as a site of metastatic disease as compared to a primary tumor site – why? Blood flow Clinical manifestations & complications o Similar to cirrhosis – portal hypertension, varices, ascites, etc. o Portal vein thrombosis & pulmonary embolism common in HCC Diagnostic studies US, CT, MRI , liver biopsy (usually avoided b/c it’s too high of a risk for bleeding) o AFP (alpha fetoprotein levels) – elevated Collaborative care o Low protein diet o Prevention & health promotion screening in high risk patients
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o Treatment Surgery – excision; liver transplant for localized HCC/primary tumor Radiofrequency ablation (radioembolization) heat tumor using electrical energy Chemoembolization cancerous liver cells exposed directly to chemo by injection through arteries by tumor bed Chemotherapy – very limited options most drugs are hepatotoxic o Palliative care Comfort measures Paracentesis Nursing diagnoses same as cirrhosis Liver Transplant Who would be a candidate? o MELD score Higher the score the more urgent o End-stage – cirrhosis o Acute liver failure, liver cancer Donor liver o Cadaver o Living (right lobe) Transplant waiting list Patient teaching what do you think is important post-transplant? o Meds – immunosuppressants for life o Abstaining from alcohol Psychosocial care & support – pre & post-transplant Key Points Differences among classifications of Hepatitis o Hep A, B, & C, autoimmune, & drug/chemical induced Acute viral hepatitis vs. chronic viral hepatitis o Clinical manifestations, treatments, etc. Cirrhosis Collaborative care of hepatic dysfunction
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  • Spring '10
  • liver disease, Hepatitis C

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